scholarly journals Relationship between comprehensive geriatric assessment and amyloid PET in older persons with MCI

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Fulvio Lauretani ◽  
Livia Ruffini ◽  
Maura Scarlattei ◽  
Marcello Maggio
Keyword(s):  
Physical Performance ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Older Persons ◽  
Neuropsychiatric Symptoms ◽  
Mean Value ◽  
Amyloid Deposition ◽  
Amyloid Pet ◽  
Hand Grip

Abstract Background The association between amyloid deposition and cognitive, behavioral and physical performance in mild cognitive impairment (MCI) due to Alzheimer’s disease (AD) has been poorly investigated, especially in older persons. Methods We studied the in vivo correlation between the amyloid deposition at Positron Emission Tomography (amyloid-PET) and the presence of memory loss, reduced executive function, neuropsychiatric symptoms and physical performance in older persons with MCI. Amyloid-PET was performed with 18F-flutemetamol and quantitatively analyzed. Results We evaluated 48 subjects, 21 men and 27 women. We performed in each patient a comprehensive geriatric assessment (CGA) including Mini Mental State Examination (MMSE), Clock Drawing Test (CDT), Activity Daily Living (ADL), Instrumental Activity of Daily Living (IADL), Neuropsychiatric inventory (NPI) questionnaire, 15 Geriatric Depression Scale (GDS), Short Physical Performance Battery (SPPB) and Hand Grip strength. Then, each patient underwent amyloid-PET. Mean age of the enrolled subjects was 74.6 ± 7.8 years. All of these subjects showed preserved cognitive function at MMSE > 24, while 29 of 48 subjects (61.0%) had altered CDT. Mean NPI score was 6.9 ± 5.9. The mean value of SPPB score was 9.0 ± 2.6, while the average muscle strength of the upper extremities measured by hand grip was 25.6 ± 7.7 Kg. CT/MRI images showed cortical atrophic changes in 26 of the 48 examined subjects (54.0%), while cerebrovascular modifications were present in 31 subjects (64.5%). Pathological burden of amyloid deposits was detected in 25 of 48 (52.0%) patients with a mean value of global z-score of 2.8 (subjects defined as MCI due to AD). After stratifying subjects in subclasses of clinical alterations, more probability of pathological amyloid deposition was found in subjects with impaired CDT and higher NPI score (O.R. = 3.45 [1.01–11.2], p = 0.04), with both impaired CDT and low physical performance (O.R. = 5.80 [1.04–32.2], p = 0.04), with altered CDT and high NPI score (O.R. = 7.98 [1.38–46.0], p = 0.02), and finally in those subjects with altered CDT, high NPI and low physical performance (O.R. = 5.80 [1.05–32.2], p = 0.04). Conclusion Our findings support the recent hypothesis that amyloid deposition could be associated with multiple cerebral dysfunction, mainly affecting executive, behavioral and motor abilities.

scholarly journals Relationship between comprehensive geriatric assessment and amyloid PET in older persons with MCI

2020 ◽  
Author(s):  
Fulvio Lauretani ◽  
Livia Ruffini ◽  
Maura Scarlattei ◽  
Marcello Maggio
Keyword(s):  
Physical Performance ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Older Persons ◽  
Neuropsychiatric Symptoms ◽  
Mean Value ◽  
Amyloid Deposition ◽  
Amyloid Pet ◽  
Hand Grip

Abstract Background. The association between amyloid deposition and cognitive, behavioral and physical performance in mild cognitive impairment (MCI) due to Alzheimer's disease (AD) has been poorly investigated, especially in older persons. Methods. We studied the in vivo correlation between the amyloid deposition at Positron Emission Tomography (amyloid-PET) and the presence of memory loss, reduced executive function, physical performance and neuropsychiatric symptoms in older persons with MCI. Amyloid-PET was performed with 18F-flutemetamol and quantitatively analyzed. Results. We evaluated 48 subjects, 21 men and 27 women. We performed in each patient a comprehensive geriatric assessment (CGA) including Mini Mental State Examination (MMSE), Clock Drawing Test (CDT), Activity Daily Living (ADL), Instrumental Activity of Daily Living (IADL), Neuropsychiatric inventory (NPI) questionnaire, 15 Geriatric Depression Scale (GDS), Short Physical Performance Battery (SPPB) and Hand Grip strength. Then, each patient underwent amyloid-PET. Mean age of the enrolled subjects was 74.6 ± 7.8 years. All of these subjects showed preserved cognitive function at MMSE > 24, while 29 of 48 subjects (61.0 %) had altered CDT. Mean NPI score was 6.9 ± 5.9. The mean value of SPPB score was 9.0 ± 2.6, while the average muscle strength of the upper extremities measured by hand grip was 25.6±7.7 Kg. CT/MRI images showed cortical atrophic changes in 26 of the 48 examined subjects (54.0 %), while cerebrovascular modifications were present in 31 subjects (64.5 %). Pathological burden of amyloid deposits was detected in 25 of 48 (52.0 %) patients with a mean value of global z-score of 2.8 (subjects defined as MCI due to AD). After stratifying subjects in subclasses of clinical alterations, more probability of pathological amyloid deposition was found in subjects with impaired CDT and higher NPI score (O.R.= 3.45 [1.01-11.2], p=0.04), with both impaired CDT and low physical performance (O.R.= 5.80 [1.04-32.2], p=0.04), with altered CDT and high NPI score (O.R.=7.98 [1.38-46.0], p=0.02), and finally in those subjects with altered CDT, high NPI and low physical performance (O.R.= 5.80 [1.05-32.2], p=0.04). Conclusion. Our findings support the recent hypothesis that amyloid deposition could be associated with multiple cerebral dysfunction, mainly affecting executive, behavioral and motor abilities.

scholarly journals Relationship between comprehensive geriatric assessment and amyloid PET in older persons with MCI

2020 ◽  
Author(s):  
Fulvio Lauretani ◽  
Livia Ruffini ◽  
Maura Scarlattei ◽  
Marcello Maggio
Keyword(s):  
Cognitive Impairment ◽  
Physical Performance ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Older Persons ◽  
Amyloid Deposition ◽  
Amyloid Pet ◽  
Clock Drawing Test ◽  
Clock Drawing ◽  
Drawing Test

Abstract Background. The association between amyloid deposition and cognitive, behavioral and physical performance in mild cognitive impairment (MCI) due to Alzheimer's disease (AD) has been poorly investigated, especially in older persons. Methods. We studied the in vivo correlation between the amyloid deposition at Positron Emission Tomography (amyloid-PET) and the presence of memory loss, reduced executive function, physical performance and neuropsychiatric symptoms in older persons with MCI due to AD. Amyloid-PET was performed with 18F-flutemetamol and quantitavely analyzed. Results. We evaluated 48 subjects, including 21 men and 27 women older than 65 years old. We performed in each patient a comprehensive geriatric assessment including MMSE, Clock Drawing Test, ADL, IADL, NPI, SPPB and Hand Grip strength. Then, each patient underwent amyloid-PET. The mean scores obtained at the MMSE by the subjects under examination was 24.97 ± 3.90 with a median NPI of 4. PET scan revealed brain amyloid deposition in 21 persons. Participants with positive amyloid scans exhibited a higher prevalence of pathological clock drawing test (p=0.0009). We did not find a significant association between MMSE score and beta amyloid plaque burden. When amyloid deposition was present, we observed that the deposition was diffuse, involving cortex in a widespread manner, as showed by alterations of CDT. Conclusion. Our findings support the recent hypothesis that amyloid deposition could be associated with multiple cerebral dysfunction, such as executive dysfunction and other cognitive impairment.

Comprehensive Geriatric Assessment Adds Information to Eastern Cooperative Oncology Group Performance Status in Elderly Cancer Patients: An Italian Group for Geriatric Oncology Study

2002 ◽  
Vol 20 (2) ◽  
pp. 494-502 ◽  
Author(s):  
Lazzaro Repetto ◽  
Lucia Fratino ◽  
Riccardo A. Audisio ◽  
Antonella Venturino ◽  
Walter Gianni ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Group Performance ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Geriatric Oncology ◽  
Oncology Group ◽  
Elderly Cancer Patients

PURPOSE: To appraise the performance of Comprehensive Geriatric Assessment (CGA) in elderly cancer patients (≥ 65 years) and to evaluate whether it could add further information with respect to the Eastern Cooperative Oncology Group performance status (PS). PATIENTS AND METHODS: We studied 363 elderly cancer patients (195 males, 168 females; median age, 72 years) with solid (n = 271) or hematologic (n = 92) tumors. In addition to PS, their physical function was assessed by means of the activity of daily living (ADL) and instrumental activities of daily living (IADL) scales. Comorbidities were categorized according to Satariano’s index. The association between PS, comorbidity, and the items of the CGA was assessed by means of logistic regression analysis. RESULTS: These 363 elderly cancer patients had a good functional and mental status: 74% had a good PS (ie, lower than 2), 86% were ADL-independent, and 52% were IADL-independent. Forty-one percent of patients had one or more comorbid conditions. Of the patients with a good PS, 13.0% had two or more comorbidities; 9.3% and 37.7% had ADL or IADL limitations, respectively. By multivariate analysis, elderly cancer patients who were ADL-dependent or IADL-dependent had a nearly two-fold higher probability of having an elevated Satariano’s index than independent patients. A strong association emerged between PS and CGA, with a nearly five-fold increased probability of having a poor PS (ie, ≥ 2) recorded in patients dependent for ADL or IADL. CONCLUSION: The CGA adds substantial information on the functional assessment of elderly cancer patients, including patients with a good PS. The role of PS as unique marker of functional status needs to be reappraised among elderly cancer patients.

CHANGES OF BODY COMPOSITION, MUSCULAR STRENGTH AND PHYSICAL PERFORMANCE DUE TO RESISTANCE TRAINING IN OLDER PERSONS WITH SARCOPENIC OBESITY

2015 ◽  
pp. 1-7
Author(s):  
K. STOEVER ◽  
A. HEBER ◽  
S. EICHBERG ◽  
W. ZIJLSTRA ◽  
K. BRIXIUS
Keyword(s):  
Resistance Training ◽  
Grip Strength ◽  
Physical Performance ◽  
Gait Speed ◽  
Older Persons ◽  
Dynamic Strength ◽  
Hand Grip Strength ◽  
Lower Limbs ◽  
Physical Parameters ◽  
Hand Grip

Background: At present, it is unclear whether older, obese persons with or without sarcopenia respond differently to training. Furthermore, there are no differentiated recommendations for resistance training for this special target group. Objectives: The objectives are to investigate the changes in the physical parameters of older, obese men caused by training and to reappraise the modalities of resistance training for older persons. Design: Pre-test-post-test design. Participants: The participants were 33 physically inactive and obese older men (≥ 65 years, BMI ≥ 30 kg/m2), with-out severe diseases. Subjects were divided into two groups: NSAR (no or presarcopenia, n= 15) or SAR (sarcopenia, n= 18). Intervention: The intervention consisted of progressive resistance training, twice a week for 16 weeks with finally 80-85% of maximum strength and three sets with 8-12 repetitions. The training contained six exercises for the major muscle groups. Measurements: Sarcopenia was assessed using the Short Physical Performance Battery (SPPB), hand-grip strength, skeletal muscle mass index (SMI), and gait speed over a 6-meter walkway. Furthermore, the maximum dynamic strength (1 RM) was assessed. Results: At baseline, the NSAR group had significantly better values in SMI, SPPB score, hand-grip strength, and 1 RM. After training, the results in both groups displayed an increase in 1 RM at the lower limbs (NSAR 18%, SAR 38%) and the upper limbs (NSAR 12%, SAR 14%). Also, the SPPB score (NSAR 11%, SAR 15%) and the 6-m-gait speed (NSAR 5%, SAR 10%) increased. The SAR group was able to increase their right hand-grip strength by 12%, whereas the NSAR group maintained their initial high strength values. SMI did not change in both groups. Conclusions: Both groups show improvements after resistance training with slightly more benefits for men with sarcopenia. Results of this study can be used to define specific training regimens for N(SAR) subjects.

scholarly journals Comprehensive geriatric assessment is correlated to overall survival among gynaecologic oncology patients

2019 ◽  
Vol 50 (3) ◽  
pp. 276-281
Author(s):  
Nadav Michaan ◽  
Sang Yoon Park ◽  
Myong Cheol Lim
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Activities Of Daily Living ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
Cancer Type ◽  
Oncology Patients

Abstract Objective To investigate the correlation of comprehensive geriatric assessment to overall survival among older gynaecologic oncology patients. Methods Between 2011 and 2017, patients >70 years had geriatric assessment before treatment. Geriatric assessment included the following tests: Old American resource and services, instrumental activities of daily living, modified Barthels index, mini-mental state examination, geriatric depression scale, mini-nutritional assessment, risk of falling and medication use. Overall survival was calculated for patients’ groups below and above median tests scores. Univariate as well as multivariate analysis was done to evaluate the association between each variable and survival. Results About 120 patients had geriatric assessment. Mean patients’ age was 76.4 ± 5. A total of 78 Patients had ovarian cancer, 16 uterine cancer, 17 cervical cancer and 9 had other gynaecologic malignancies. No correlation was found between age, BMI (body mass index) and cancer type to overall survival. Patients with scores below cut-off values of modified Barthels index, instrumental activities of daily living, mini-nutritional assessment and mini-nutritional assessment had significantly shorter overall survival (P = 0.004, 0.031, 0.046 and 0.004, respectively). This remained significant in both univariate and multivariate analysis. Conclusions Gynaecologic oncology patients with lower geriatric assessment scores have significantly lower overall survival, irrespective of cancer type. Geriatric assessment tests allow objective assessment of older patients with worst prognosis before treatment planning.

scholarly journals P0806RESIDUAL RENAL FUNCTION IS COMPLEMENTARY TO GERIATRIC ASSESSMENT SCORE IN ASSESSING CLINICAL RISK OF ELDERLY PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Alberto Castagna ◽  
Davide Bolignano ◽  
Irma Figlia ◽  
Rosa Paola Cerra ◽  
Carmen Ruberto ◽  
...  
Keyword(s):  
Renal Function ◽  
Risk Stratification ◽  
Activities Of Daily Living ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
The Elderly ◽  
Residual Renal Function ◽  
Elderly Subjects ◽  
Old Patients

Abstract Background and Aims Renal function impairment is highly pervasive in the elderly and triggers increased morbidity and mortality. Comprehensive geriatric assessment (CGA) is a validated multidisciplinary instrument to assess medical, psychosocial and functional limitations of old patients with diagnostic and risk-stratification purposes. In a focused cohort of frail individuals, we aimed at evaluating possible relationships between single CGA items and renal function. Method 254 consecutive elderly subjects (mean age 79.9±6.6 years, female 65.8%) from the geriatric division of a large Italian community hospital were studied. We collected clinical data including CGA and renal function (CKD-EPI formula). CGA single items included the Cumulative Illness Rating Scale (CIRS), the Exton Smith Scale (ESS), the Mini Nutritional Assessment Short Form (MNA-SF), the Katz‘s Activities of Daily Living (ADL), the Lawton’s Instrumental Activities of Daily Living (IADL), the Short Portable Mental Status Questionnaire (SPMSQ) and the amount of drugs administered (AD). Results Mean eGFR was 66.37±30.94 mL/min/1.73 m2. Overall, the reported CIRS, ESS, MNA, ADL and AD scores were low (7.6±3.3) while IADL and SPMQ were on a mild range, denoting a potential alarm signal for poor prognosis and the risk for adverse outcomes. At univariate analyses, eGFR was significantly associated with CIRS (R=-0.389, p<0.0001), ESS (R=0.355, p<0.0001), MNA (R=0.394, p<0.0001), ADL (R=0.394, p<0.0001), AD (R=-0.374, p<0.0001. while a weak, although significant correlation was found with IADL (R=0.131, p=0.038) and SPMSQ (R=-0.141, p=0.038). In a fully adjusted multivariate analyses only SPMSQ (ß=-0.174, p=0.04), ADL (ß=0.182, p=0.012), IADL (ß =0.209, p=0.003) and AD (ß=-0.354, p<0.0001) remained significant predictors of residual renal function. Conclusion In elderly frail subjects, residual renal function may influence daily life and cognitive activities, the perceived quality of living and the entity of drug assumption. Inclusion of renal function within a comprehensive geriatric assessment could help improving risk stratification in the elderly

Comprehensive geriatric assessment decreases prevalence of orthostatic hypotension in older persons

2013 ◽  
Vol 41 (4) ◽  
pp. 351-358 ◽  
Author(s):  
Pasi Lampela ◽  
Piia Lavikainen ◽  
Risto Huupponen ◽  
Esko Leskinen ◽  
Sirpa Hartikainen
Keyword(s):  
Orthostatic Hypotension ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Older Persons

Multidimensional geriatric evaluation in elderly cancer patients and its relationship with age

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19651-19651
Author(s):  
M. Molina-Garrido ◽  
C. Guillén-Ponce ◽  
A. Carrato
Keyword(s):  
Health Status ◽  
Activities Of Daily Living ◽  
Cancer Patients ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Older Patients ◽  
Patients With Cancer ◽  
Medication Intake ◽  
Oncologic Patients

19651 Background: Age is the major risk factor for the majority of patients with cancer. More than 50% of cancers occurs after the age of 60. Older patients are not simply old, but are geriatric patients because of interacting psychosocial and physical problems. As a consequence, the health status of old persons cannot be evaluated by merely describing the single disease or the group of age. We tested the performance of a new Comprehensive Geriatric Assessment (CGA) and its relationship with groups of age in cancer patients. Methods: Between June 2006 and December 2006, a total of 64 oncologic patients older than 75 years were approached to enrol in our study to analyze their functional, physical, mental, pharmacotherapeutic and socio-economic status and to correlate them to some groups of age: youngest-old (75 to 80 years-old), old-old (80 and 85 years-old) and oldest-old (older than 85 years). They were analysed Activities of Daily Living (ADL) measured by Barthel Scale, Instrumental Activities of Daily Living (IADL) measured by Lawton-Brody Scale, Grade of Fragility measured by Barber Scale, cognitive evaluation measured by Pfeiffer Test, and medication intake. A Chi Squared test was used for statistical analysis; p-value <0,05 was considered significative. Results: Sixty-four oncologic patients age > or = 75 years were recruited. Median age was 80.24 years (range 73.88 to 86.94). 51.6% female. Breast cancer was the most frequent diagnosis (30.2%), followed by lung cancer (19%). 29 patients (45.3%) were aged between 75 and 80 years old; 27 patients (43.5%) were between 80 and 85 years- old. There were statistic significative association between groups of age and Pfeiffer Test (p=0.037), Barber Scale (p=0.031) and medication intake (p=0.021). However, there was not a significative relationship between groups of age and Barthel Scale (p=0.052), Lawton-Brody Scale (p=0.2425), Cruz-Roja Scale (p=0,1485) or number of geriatric syndromes (p=0.129). Conclusions: This abstract reviews the findings regarding the correlation between a comprehensive geriatric assessment (CGA) and groups of age in older patients with cancer. Age per se must not be the only criterion for medical decision as it is not correlated to the health status of older cancer patients. No significant financial relationships to disclose.

The ability of physical performance test and Karnofsky performance status to identify elderly cancer patients requiring a comprehensive geriatric assessment: A comparative study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20534-e20534
Author(s):  
Najib Antoine Nassani ◽  
Sassine Ghanem ◽  
Elie Kassouf ◽  
Lana El Osta ◽  
Fadi El Karak ◽  
...  
Keyword(s):  
Physical Performance ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Performance Test ◽  
Screening Tool ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Geriatric Oncology ◽  
Physical Performance Test ◽  
Sleeping Problems

e20534 Background: The role of Physical Performance Test (PPT) as a screening tool for patients in geriatric oncology requiring a Comprehensive Geriatric Assessment (CGA) has not been studied so far. We undergo this study to assess PPT as a screening tool in comparison with Karnofsky Performance Status (KPS) and CGA. Methods: One hundred patients, aged ≥ 70 and diagnosed with cancer participated in our study. Inclusion criteria were knowledge of Arabic, French or English and absence of significant cognitive impairment. Exclusion criteria were: KPS<60% or severe medical condition. ROC curves were used to compare PPT and KPS in identifying ≥ 2 impairments on CGA. Results: Median age was 76 years (70 – 89). Most frequent malignancies were: Lung (19%), colo-rectum (16%), and breast (15%). Stage IV was present in half of patients. Patients were at increased risk of malnutrition (46%) and malnourished (15%), had moderate to severe pain uncontrolled by medication (41%), were at risk of falls (42%), were suffering from frequent sleeping problems (43%), had vision (56%) and hearing (36%) impairment, have had urinary incontinence within one year (21%). All had social support in case of emergency. Cardiovascular (67%), diabetes mellitus (30%) and pulmonary (26%) were the most frequent comorbidities. A remarkable prevalence of geriatric problems was noted with 69% having ≥ 2 impairments on CGA. A good correlation existed between KPS and PPT r = 0.68 (p<.0001). PPT (Se=65%, Sp=84%, PPV=90%, NPV=52%, cut-off ≤24) was equivalent to KPS (Se=65%, Sp=81%, PPV=88%, NPV=51%, cut-off ≤80%) in identifying ≥ 2 impairments on CGA. Conclusions: Patients aged ≥ 70, diagnosed with cancer and having a KPS ≤ 80% or a PPT ≤ 24 must be referred to specialists in geriatric oncology or to geriatricians for a thorough assessment.

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